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Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy
Journal of Minimally Invasive Gynecology (2005) 12, 382
Capsule summaries Clinical evaluation of a viscoelastic gel for reduction of adhesions following gynaecological surgery by laparoscopy in Europe Hum Reprod 2005;20:514-520 By Lundorff P, Donnez J, Korell M, Audebert AJ, Block K, and diZerega GS This is the first laparoscopic study to review the antiadhesion adjuvant Oxiplex/AP gel. This viscoelastic gel (consisting of polyethylene oxide and carboxymethylcellulose) was introduced laparoscopically through a 5-mm accessory cannula. Approximately 30 mL of gel was required to coat both adnexa, with the total application time averaging about 90 seconds. Forty-nine patients were prospectively randomized to either the treatment or the control group. The study found the treated adnexa to be less likely to develop adhesions compared with the control adnexa. No complications were observed in this small study. This antiadhesion barrier is obviously easier to place than sheets such as Interceed or Preclude and is more comparable to SprayGel. Of note, it was not efficacious in patients with severe adhesions and stage 4 endometriosis. This is consistent with the fact that adhesion reformation is much more difficult to prevent than de novo adhesion formation. Although promising, additional studies will be required to confirm efficacy. Summarized by Gary Frishman, MD
Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy
1553-4650/$ -see front matter © 2005 AAGL. All rights reserved. doi:10.1016/j.jmig.2005.06.001
Hum Reprod 2005;20:258-263 By Campo R, Molinas CR, Rombauts L, Mestdagh G, Lauwers M, Braekmans P, Brosens I, Van Belle Y, and Gordts S Smaller diameter hysteroscopes, along with other improvements in technology, have led to an increase in office hysteroscopy. However, some physicians question whether a smaller diameter hysteroscope provides adequate visualization. This large, multicenter randomized trial evaluated a 5-mm (30-degree) compared with a 3.5-mm (30- or 12degree) rigid hysteroscope with normal saline used as the distention media. A total of 480 women were randomized to one of two groups. Parameters studied included the experience of the surgeon, patient parity, and size of the hysteroscope. The procedure was considered successful if the pain score was less than 4 (on a scale of zero to 10), the cavity was adequately visualized (greater than 1 on a scale of zero to 3), and no complications occurred. Successful procedures were more likely to be achieved in patients who had had vaginal deliveries, when the procedure was performed by the experienced surgeon, and when the mini-hysteroscope (3.5 mm outer diameter) was used. Minor procedures (e.g., polyp removal and/or minor adhesions, etc.) and flexible hysteroscopes were not discussed in the paper. As such, when a physician (especially one who lacks experience with hysteroscopy) is thinking of using a rigid hysteroscope in the office, he or she can consider using a hysteroscope with a smaller outer diameter without fear of compromising the ability to see and with a greater likelihood of a successful procedure. Summarized by Gary Frishman, MD
Capsule summaries Clinical evaluation of a viscoelastic gel for reduction of adhesions following gynaecological surgery by laparoscopy in Europe Hum Reprod 2005;20:514-520 By Lundorff P, Donnez J, Korell M, Audebert AJ, Block K, and diZerega GS This is the first laparoscopic study to review the antiadhesion adjuvant Oxiplex/AP gel. This viscoelastic gel (consisting of polyethylene oxide and carboxymethylcellulose) was introduced laparoscopically through a 5-mm accessory cannula. Approximately 30 mL of gel was required to coat both adnexa, with the total application time averaging about 90 seconds. Forty-nine patients were prospectively randomized to either the treatment or the control group. The study found the treated adnexa to be less likely to develop adhesions compared with the control adnexa. No complications were observed in this small study. This antiadhesion barrier is obviously easier to place than sheets such as Interceed or Preclude and is more comparable to SprayGel. Of note, it was not efficacious in patients with severe adhesions and stage 4 endometriosis. This is consistent with the fact that adhesion reformation is much more difficult to prevent than de novo adhesion formation. Although promising, additional studies will be required to confirm efficacy. Summarized by Gary Frishman, MD
Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy
1553-4650/$ -see front matter © 2005 AAGL. All rights reserved. doi:10.1016/j.jmig.2005.06.001
Hum Reprod 2005;20:258-263 By Campo R, Molinas CR, Rombauts L, Mestdagh G, Lauwers M, Braekmans P, Brosens I, Van Belle Y, and Gordts S Smaller diameter hysteroscopes, along with other improvements in technology, have led to an increase in office hysteroscopy. However, some physicians question whether a smaller diameter hysteroscope provides adequate visualization. This large, multicenter randomized trial evaluated a 5-mm (30-degree) compared with a 3.5-mm (30- or 12degree) rigid hysteroscope with normal saline used as the distention media. A total of 480 women were randomized to one of two groups. Parameters studied included the experience of the surgeon, patient parity, and size of the hysteroscope. The procedure was considered successful if the pain score was less than 4 (on a scale of zero to 10), the cavity was adequately visualized (greater than 1 on a scale of zero to 3), and no complications occurred. Successful procedures were more likely to be achieved in patients who had had vaginal deliveries, when the procedure was performed by the experienced surgeon, and when the mini-hysteroscope (3.5 mm outer diameter) was used. Minor procedures (e.g., polyp removal and/or minor adhesions, etc.) and flexible hysteroscopes were not discussed in the paper. As such, when a physician (especially one who lacks experience with hysteroscopy) is thinking of using a rigid hysteroscope in the office, he or she can consider using a hysteroscope with a smaller outer diameter without fear of compromising the ability to see and with a greater likelihood of a successful procedure. Summarized by Gary Frishman, MD